{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T08:42:52Z","timestamp":1792312972487,"version":"4.4.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010270","name":"Capital Health Research and Development of Special","doi-asserted-by":"publisher","award":["2022-1-2051"],"award-info":[{"award-number":["2022-1-2051"]}],"id":[{"id":"10.13039\/501100010270","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the feasibility and effect of a pedicled submental flap in postoperative defect repair of nasopharyngeal malignant tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eight cases (six women, two men; age, 29\u201363 years) of postoperative defects after resection of malignant nasopharyngeal tumors with a lesion stage of (r) T<jats:sub>1\u20133<\/jats:sub>N<jats:sub>0\u20132<\/jats:sub>M<jats:sub>0<\/jats:sub> were retrospectively analyzed. Preoperative enhanced thin-slice computed tomography of the neck was performed to predict the submental flap reflux vein. The submental flap was prefabricated during the operation, and the nasopharyngeal mass was removed through the parapharyngeal space approach combined with nasal endoscopy\/mandibular external rotation\/maxillary overturning. The submental flap was elevated to the nasopharyngeal defect area through the parapharyngeal space for repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Intraoperative examination confirmed that among the eight submental flaps, three had venous drainage into the internal jugular vein and five had venous drainage into the external jugular vein; these findings were consistent with the preoperative computed tomography findings. The size of the submental flap was 8\u201310\u2005cm\u2009\u00d7\u20095\u20136\u2005cm. The repair range reached the eustachian orifice on the healthy side and extended to the posterior wall of the maxillary sinus on the affected side. The flap extended to the posterior upper part of the nasal septum at the top, to the oropharynx at the bottom, and to the bony surface of the skull base at the deep side. Primary healing after surgery was achieved, and no flap necrosis occurred. After 3\u201377 months of follow-up, one patient with recurrent nasopharyngeal carcinoma after radiotherapy developed cervical lymph node recurrence again, one patient with adenoid cystic carcinoma had lung metastasis, and the remaining six patients had no recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The pedicled submental flap is used to repair postoperative defects in the nasopharyngeal region through the cervical parapharyngeal space. It is a simple and fast procedure with adequate tissue volumes. The flap can effectively protect important structures such as the internal carotid artery and reduce the risk of infection and bleeding from postoperative wound exposure.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.985752","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T04:46:31Z","timestamp":1667191591000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Reconstruction of nasopharyngeal defect with submental flap during surgery for nasopharyngeal malignant tumors"],"prefix":"10.3389","volume":"9","author":[{"given":"Hongzhi","family":"Ma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jugao","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizhen","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shizhi","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.wjorl.2015.09.006","article-title":"Salvage surgery for nasopharyngeal cancer","volume":"1","author":"Tsang","year":"2015","journal-title":"World J Otorhinolaryngol Head Neck Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1002\/hed.24451","article-title":"Relapse status as a prognostic factor in patients receiving salvage surgery for recurrent or residual nasopharyngeal cancer after definitive treatment","volume":"38","author":"Chee","year":"2016","journal-title":"Head Neck"},{"key":"B3","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1002\/hed.20161","article-title":"Survival outcome of patients with nasopharyngeal carcinoma with first local failure: a study by the Hong Kong nasopharyngeal carcinoma study group","volume":"27","author":"Yu","year":"2005","journal-title":"Head Neck"},{"key":"B4","doi-asserted-by":"publisher","first-page":"703954","DOI":"10.3389\/fonc.2021.703954","article-title":"Comparing the effectiveness of endoscopic surgeries with intensity-modulated radiotherapy for recurrent rT3 and rT4 nasopharyngeal carcinoma: a meta-analysis","volume":"11","author":"Peng","year":"2021","journal-title":"Front Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/1748-717X-9-87","article-title":"Local failure patterns for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy","volume":"9","author":"Li","year":"2014","journal-title":"Radiat Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3356","DOI":"10.1200\/JCO.2015.60.9347","article-title":"Management of nasopharyngeal carcinoma: current practice and future perspective","volume":"33","author":"Lee","year":"2015","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1007\/s00405-010-1385-x","article-title":"Current treatment options for recurrent nasopharyngeal cancer","volume":"267","author":"Su\u00e1rez","year":"2010","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1186\/s12885-018-5055-5","article-title":"Long-term survival and late complications of intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma","volume":"18","author":"Kong","year":"2018","journal-title":"BMC Cancer"},{"key":"B9","doi-asserted-by":"publisher","first-page":"716729","DOI":"10.3389\/fonc.2021.716729","article-title":"Clinical outcomes of salvage endoscopic nasopharyngectomy for patients with advanced recurrent nasopharyngeal carcinoma","volume":"11","author":"Li","year":"2021","journal-title":"Front Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1177\/01945998211011076","article-title":"Endoscopic nasopharyngectomy combined with internal carotid artery pretreatment for recurrent nasopharyngeal carcinoma","volume":"166","author":"Wang","year":"2022","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1002\/cac2.12159","article-title":"Retreatment in locally recurrent nasopharyngeal carcinoma: current status and perspectives","volume":"41","author":"Poh","year":"2021","journal-title":"Cancer Commun"},{"key":"B12","doi-asserted-by":"publisher","first-page":"S97","DOI":"10.1017\/S0022215116000517","article-title":"Nasopharyngeal carcinoma: United Kingdom national multidisciplinary guidelines","volume":"130","author":"Simo","year":"2016","journal-title":"J Laryngol Otol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/S1470-2045(20)30673-2","article-title":"Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial","volume":"22","author":"Liu","year":"2021","journal-title":"Lancet Oncol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"555862","DOI":"10.3389\/fonc.2020.555862","article-title":"Types of transnasal endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: Shanghai EENT Hospital Experience","volume":"10","author":"Liu","year":"2021","journal-title":"Front Oncol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"713926","DOI":"10.3389\/fsurg.2021.713926","article-title":"Preliminary efficacy report and prognosis analysis of endoscopic endonasal nasopharyngectomy for recurrent nasopharyngeal carcinoma","volume":"8","author":"Peng","year":"2021","journal-title":"Front Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40463-020-00482-x","article-title":"5-Year outcomes of salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma","volume":"50","author":"Thamboo","year":"2021","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.radonc.2015.04.024","article-title":"Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1-T3 nasopharyngeal carcinoma: a case-matched comparison","volume":"115","author":"You","year":"2015","journal-title":"Radiother Oncol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1002\/hed.23719","article-title":"Salvage endoscopic nasopharyngectomy and intensity-modulated radiotherapy versus conventional radiotherapy in treating locally recurrent nasopharyngeal carcinoma","volume":"37","author":"Zou","year":"2015","journal-title":"Head Neck"},{"key":"B19","doi-asserted-by":"publisher","first-page":"720418","DOI":"10.3389\/fonc.2021.720418","article-title":"Outcomes of recurrent nasopharyngeal carcinoma patients treated with salvage surgery: a meta-analysis","volume":"11","author":"Feng","year":"2021","journal-title":"Front Oncol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"215","DOI":"10.16066\/j.1672-7002.2021.04.005","article-title":"A pilot study to dissect the nasal pharyngeal cancer via a combined method of nasal endoscope and trans-parapharyngeal space","volume":"28","author":"Fang","year":"2021","journal-title":"Chin Arch Otolaryngol Head Neck Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1007\/s12070-007-0040-3","article-title":"Impact of nasal polyps on quality of life of chronic sinusitis patients","volume":"59","author":"Vaid","year":"2007","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"178","DOI":"10.22603\/ssrr.2019-0090","article-title":"Transoral mandibular tongue-splitting approach in upper cervical epidural abscess: a case report and review of the literature","volume":"4","author":"Kobayashi","year":"2020","journal-title":"Spine Surg Relat Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1002\/hed.26121","article-title":"Submental island flap vs free tissue transfer in oral cavity reconstruction: systematic review and meta-analysis","volume":"42","author":"Hu","year":"2020","journal-title":"Head Neck"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2406","DOI":"10.1097\/SCS.0000000000007930","article-title":"Comprehensive review of the submental flap in head and neck and facial reconstruction: what plastic surgeons need to know","volume":"32","author":"Hamidian Jahromi","year":"2021","journal-title":"J Craniofac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e3606","DOI":"10.7717\/peerj.3606","article-title":"Vascular anatomy is a determining factor of successful submental flap raising: a retrospective study of 70 clinical cases","volume":"5","author":"Lin","year":"2017","journal-title":"PeerJ"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.985752\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T04:46:35Z","timestamp":1667191595000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.985752\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,31]]},"references-count":25,"alternative-id":["10.3389\/fsurg.2022.985752"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.985752","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,31]]},"article-number":"985752"}}